Agrigoroaei, S., & Lachman, M.E. (2011).

Cognitive functioning in midlife and old age: combined effects of psychosocial and behavioral factors. The Journals of Gerontology, Series B: Psychological
Sciences and Social Sciences, 66B(S1), i130–i140, doi:10.1093/geronb/gbr017

Cognitive Functioning in Midlife and Old Age: Combined

Effects of Psychosocial and Behavioral Factors
Stefan Agrigoroaei and Margie E. Lachman

Department of Psychology, Brandeis University, Waltham, Massachusetts.

Objectives.  This study examined the joint protective contribution of psychosocial and behavioral factors to cognitive
functioning and 10-year change, beyond the influence of sociodemographic factors, physical risk factors, health status,
and engagement in cognitive activities.

Methods.  Participants were from the National Study of Midlife in the United States (MIDUS), ages 32–84 at Time 2,
and a subsample, the Boston Longitudinal Study (BOLOS), ages 34–84 at Time 2. We computed a composite protective

Downloaded from psychsocgerontology.oxfordjournals.org at University of Wisconsin-Madison General Library System on August 31, 2011
measure including control beliefs, quality of social support, and physical exercise variables at two occasions, 9–10 years
apart. Cognition was assessed at Time 2 in MIDUS and at both occasions in BOLOS. Multiple regressions were used for
analysis.

Results.  In MIDUS, the more of the protective factors, the better the cognitive performance, and the protective com-
posite moderated education differences in memory. In BOLOS, the Time 1 composite predicted change in reasoning
abilities, with a greater protective effect for those with lower education.

Discussion.  A combination of modifiable psychosocial and behavioral factors has both concurrent and long-term
protective effects on cognition in adulthood. The results are promising in that educational disparities in memory and
reasoning were reduced, suggesting possible interventions to protect against cognitive declines.

Key Words:  Aging—Cognition—Control beliefs—Health—Physical exercise—Social support.

A LTHOUGH there is evidence for average declines in

cognition with aging, there is wide variability in the
nature and extent of these changes (Hofer & Alwin, 2008).
beyond the role of sociodemographic variables, the well-
established risk factors, and cognitive activities.

A large number of theoretical models and empirical evi-
dence from cross-sectional, longitudinal, and intervention
studies suggest the potential of behaviors and beliefs to
enhance cognitive functioning (for a review, see Hertzog,
Kramer, Wilson, & Lindenberger, 2008). The consensus is
that cognitive performance can be optimized and main-
tained by modifiable lifestyle factors and engagement in
health-promoting or protective behaviors (Yaffe et al.,
2009). Previous studies (e.g., Lachman, Agrigoroaei,
Murphy, & Tun, 2010; Small & McEvoy, 2008) have shown
that engaging in frequent cognitive activities is associated
with superior cognitive performance. Three other modifi-
able psychosocial and behavioral factors are consistently
found to show positive associations with cognition: control
beliefs, quality of social support, and physical exercise.
Although their individual benefits have been shown in past
work, they have not been studied together, in an additive
approach, or considered in the context of physical health or
physical risk factors such as being overweight, smoking,
having alcohol, or drug problems, in a national sample of
adults with a wide age range. Thus, the goal of the present
study was to examine the combined contribution of psycho-
logical, social, and physical factors to cognitive functioning
and change and to consider their possible protective effects
i130
Between-person Heterogeneity in Cognition
There is widespread evidence for age differences in cogni-
tive abilities (Salthouse, 2009). Within age groups, interindi-
vidual differences have traditionally been explained by
sociodemographic inequalities such as level of educational
attainment (Alley, Suthers, & Crimmins, 2007). Another
explanatory factor, that is becoming more and more visible in
the theoretical and empirical models of cognitive decline, is
physical health. The conjoint trajectories of health and cogni-
tion are complex (Spiro & Brady, 2008). There is evidence
that physical health and cognitive functioning are interdepen-
dent, in the sense that they share common variance and un-
derlying etiologies. Beside the role of physical health level,
those adults with health risk factors such as being overweight
(Nilsson & Nilsson, 2009), smoking (Anstey, von Sanden,
Salim, & O’Kearney, 2007), and having alcohol problems
(Lopes, Furtado, Ferrioli, Litvoc, & de Campos Bottino,
2010) are more likely to have poor cognitive performance. In
addition, there is increasing evidence that modifiable psycho-
logical, social, and physical behavioral factors including a
sense of control, quality of social support, and physical exer-
cise are associated with improved cognitive performance
(Colcombe & Kramer, 2003; Miller & Lachman, 2000;
Seeman, Lusignolo, Albert, & Berkman, 2001).
© The Author 2011. Published by Oxford University Press on behalf of The Gerontological Society of America.
All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Received March 17, 2010; Accepted February 16, 2011
Decision Editor: Sherry Willis, PhD
 PROTECTIVE FACTORS FOR COGNITION
The contribution of control beliefs
According to a variety of studies, one central ingredient
for good cognitive performance is control beliefs (Bielak
et al., 2007; Caplan & Schooler, 2003; Lachman, 2006;
Miller & Lachman, 2000). Control beliefs involve the per-
ception that one can influence what happens in one’s life
and to what extent one’s actions can bring about desired
outcomes, such as good cognitive functioning. It includes
beliefs or expectations about one’s abilities and perceptions
about external constraints (Lachman, 2006). A lowered
sense of control may have affective, behavioral, motiva-
tional, and physiological effects, including greater levels of
stress and anxiety (Kirschbaum et al., 1995), lower levels of
effort, persistence, and strategy use (Hertzog, McGuire, &
Lineweaver, 1998; Lachman & Andreoletti, 2006), as well
as less frequent engagement in memory tasks (West &
Yassuda, 2004), which can impact cognitive performance.
Although much of the work has been cross-sectional and
correlational, there is longitudinal evidence that those who
have higher control beliefs improve more on cognitive tests
with practice and also are less likely to show aging-related
declines in cognitive functioning over time (Caplan &
Schooler, 2003).
The contribution of social support
Social interactions involve a combination of supportive
and stressful experiences. There is ample evidence that so-
cial exchanges, broadly defined, are related to cognitive
functioning (Béland, Zunzunegui, Alvarado, Otero, &
del Ser, 2005; Seeman et al., 2001). With respect to support
from others, some have shown that emotional support, but
not instrumental support, is positively related to better over-
all cognitive performance (Seeman et al., 2001). Among the
explanatory mechanisms that have been considered, physi-
ological factors such as stress hormones, immune function-
ing, and inflammatory processes affect the central nervous
system and may be exacerbated for those with lower social
support (Berkman, Glass, Brissette, & Seeman, 2000).
The contribution of physical exercise
The benefits of physical exercise for cognitive outcomes
are widely documented (Colcombe & Kramer, 2003; Jedrz-
iewski, Lee, & Trojanowski, 2007). As shown by interven-
tions and epidemiologic studies, those who engage in
regular exercise are more likely to perform better on cogni-
tive tasks such as memory (Lachman, Neupert, Bertrand, &
Jette, 2006), executive functioning (Kramer et al., 1999),
and speed of processing (Dik, Deeg, Visser, & Jonker,
2003). Studies have suggested that the effects of exercise
are most pronounced for executive functioning (Colcombe
& Kramer, 2003; Hall, Smith, & Keele, 2001). With respect
to long-term effects of physical activities, some results
showed that engaging in exercise between the ages of
15 and 25 can lead to better cognition in old age (Dik et al.,
i131
2003). Possible mechanisms linking exercise and cognitive
health include increased levels of oxygenation (Hertzog
et al., 2008). Also, work on brain changes has revealed an
increase in neuromuscular activity and cerebral blood flow
(Rogers, Meyer, & Mortel, 1990) and the release of neuro-
trophins and catecholamines (McMorris, Collard, Corbett,
Dicks, & Swain, 2008) as processes associated with physi-
cal activity that are also beneficial for cognition.
The combined effects of psychosocial and behavioral
factors
Previous studies on predictors of cognitive functioning
focus on the independent contributions of key factors. More
recently, there has been an emphasis on the cumulative ef-
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fects of multiple sources. For example, Sabia et al. (2009)
showed that the total number of unhealthy risk behaviors in
which one person engages, such as smoking, heavy drink-
ing, unhealthy nutrition, and lack of physical activity, was
associated with low cognitive performance in later life. The
procedure of aggregating different sources of influence is
consistent with studies from the medical literature suggest-
ing that health-related lifestyle factors are not randomly dis-
tributed in the general population, but that they tend to
occur in combination with each other within individuals
(Poortiga, 2007). By analogy, one can think about the per-
sonal cardiovascular risk index or about allostatic load
(Seeman et al., 2004) that comprise several health indica-
tors and predict disease better than individual markers. We
believe that developing a meaningful summary score of
psychosocial and behavioral domains on which respondents
had an adaptive level is theoretically and empirically inter-
esting. Of interest is whether there is additive value for en-
gaging in multiple adaptive behaviors by considering an
index of protective factors. Only a modest literature has ad-
dressed the relationship between multiple protective psy-
chosocial and behavioral factors and cognition (e.g., Albert
et al., 1995; Newson & Kemps, 2006; Sturman et al., 2005),
and we know of no studies showing their combined effects.
One related study (Karp et al., 2006) considered the com-
bined mental, physical, and social components embodied
simultaneously in leisure activities and linked them to the
risk for dementia. The most beneficial effects were obtained
for those with higher scores in all three or in two of the
components. Our study represents a similar approach with a
focus on individual differences in normal cognitive func-
tioning for a middle-aged and older sample. Compared with
the previous work, largely focused on the positive associa-
tion between engagement in mentally stimulating activities
and cognition (e.g., Hertzog, 2009; Lachman et al., 2010),
the current study considered the role of “noncognitive”
behaviors and psychosocial factors. We analyzed frequent
engagement in vigorous physical activities in combination
with high control beliefs and quality of social support as
protective factors for cognitive performance and change.
i132 AGRIGOROAEI AND LACHMAN
Table 1.  Comparison Between the Longitudinal Participants and the Dropouts in Midlife in the United States Study
Variable (Time 1) Longitudinal (N = 4,955)
Age, mean (SD) in years 46.48 (12.50)
Women, % 53.3
Education, mean (SD) in years 14.02 (2.60)
Non-Hispanic White, % 93.0
Waist circumference, mean (SD) in inches 35.33 (5.75)
Do smoke, % 19.6
Do have alcohol or drug problems, % 2.2
Health status, mean (SD) 0.26 (0.53)
Control beliefs, mean (SD) 5.54 (1.00)
Quality of social support, mean (SD) 3.18 (0.37)
Physical exercise, mean (SD) 3.20 (1.69)
Note: p values for means are derived from independent samples t-tests; p values for percentages are derived from c2 tests.
The current study
The present study used data from the Midlife in
the United States (MIDUS; Brim, Ryff, & Kessler, 2004)
national longitudinal survey conducted in 1995–1996 and
2004–2005 and a subsample, the Boston Longitudinal
Study (BOLOS). The BOLOS measurements were taken
approximately one year after each of the MIDUS measure-
ments. MIDUS was designed to investigate the role of
behavioral, social, psychological, biological, and neurologi-
cal factors in understanding physical and mental health as
people age. Thus, it has the benefit of data on a diverse pop-
ulation in terms of sociodemographic profiles and levels of
physical health and cognitive functioning. The general goal
of the present study was to analyze whether a protective
composite comprising a strong sense of control over life
outcomes, high quality of social relationships with partners,
friends and family, and frequent vigorous physical exercise
is associated with better cognitive performance in MIDUS
and maintaining better cognitive functioning over a 10-year
period in BOLOS. We expected a main effect of this
aggregate over and above the role of sociodemographic
variables, physical risk factors, health status, and frequency
of engagement in cognitive activities.
At MIDUS Time 2, when our variables of interest were
measured cross-sectionally, we hypothesized that the more
of the psychosocial and behavioral factors present, the bet-
ter the cognitive performance. Also, we analyzed if the
magnitude of the combined effect of the factors on cogni-
tive functioning would vary for the older adults and those
with lower education (i.e., those considered at higher risk
for poor cognitive performance). We then examined to what
extent changes in the number of protective factors from
Time 1 to Time 2 were associated with better cognition at
Time 2.
The BOLOS study allowed us to take a first look at indi-
vidual differences in cognitive decline. We predicted that
the protective composite at Time 1 would account for varia-
tions in change between the two waves of the BOLOS study.
We also tested if change in the number of factors over time
predicted change in cognition and whether the protective
Dropouts (N = 2,145) p Value
46.21 (14.10) .457
47.8 <.001
13.13 (2.60) <.001
84.0 <.001
35.63 (5.79) .082
30.6 <.001
3.6 .002
0.33 (0.64) <.001
5.38 (1.09) <.001
3.13 (0.43) <.001
2.96 (1.81) <.001
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composite led to better levels of cognitive maintenance in
older people and respondents with lower education, those
considered most vulnerable to declines.
Methods
Participants
A national probability sample (N = 4,238) of noninstitu-
tionalized adults from the 48 contiguous states was selected
using random-digit dialing (RDD) of telephone numbers
with age and gender information about the household com-
position, with an overall response rate of 70% for the tele-
phone interview (Brim et al., 2004). The study also included
siblings (N = 949) of the main respondents, randomly
selected from the RDD sample, as well as a subpopulation of
twins (N = 1,913) obtained after screening a representative
national sample of approximately 50,000 households. At
Time 1 (N = 7,100), participants ranged in age from 24 to 75
years (M = 46.40, SD = 13.00). At Time 2, the longitudinal
retention rate, adjusted for mortality, was 75% (N = 4,955),
with age ranging from 32 to 84 years (M = 55.45, SD =
12.44). As is typically found, those who participated at the
second wave showed positive selection on most variables
(Table 1), compared with those who dropped out of the study.
Approximately 12 months after MIDUS Time 1, 302
MIDUS participants, ranging in age from 24 to 74 years
(M = 47.89, SD = 13.74), who were from an oversample
drawn in the Boston area, were successfully recruited to
participate in BOLOS. Within one year of completion of
the MIDUS Time 2, 222 people from BOLOS were located;
180 of them were recontacted (81% contact rate) and 151
(68%) participated. Their ages at Time 2 ranged from 34 to
84 years (M = 59.99, SD = 12.81). Compared with those
who did not participate in BOLOS Time 2, longitudinal
participants from the Boston area were more educated—
M = 15.13 vs. M = 14.24, t(300) = –2.77, p = .006. However,
they did not differ in terms of age, M = 49.21 vs. M = 46.57,
t(300) = –1.68, p = .095, self-rated physical health, M =
7.50 vs. M = 7.24, t(300) = –1.32, p = .188, or sex distribu-
tion, women: 43.7% vs. 38.4%, c2(1) = .88, p = .349.
 PROTECTIVE FACTORS FOR COGNITION
Measures
Cognition.—Cognitive measures were collected by tele-
phone at Time 2 in MIDUS and at Time 1 and Time 2 in
person for BOLOS.
MIDUS cognitive battery. In MIDUS, seven cognitive di-
mensions were tested using the Brief Test of Adult Cogni-
tion by Telephone (Lachman & Tun, 2008; Tun & Lachman,
2008). This included two measures of episodic memory
(immediate and delayed free recall of 15 words), working
memory span (backward digit span—the highest span
achieved in repeating strings of digits in reverse order), ver-
bal fluency (the number of words produced from the catego-
ry of animals in 60 s), inductive reasoning (completing a
pattern in a series of 5 numbers), processing speed (the
number of digits produced by counting backward from 100
in 30 s), and attention switching and inhibitory control (the
Stop and Go Switch Task; Tun & Lachman, 2008). For the
latter task, reaction times were calculated with the mean of
switch and nonswitch trial latencies on a task requiring al-
ternating between the “normal” condition (i.e., respond
“Go” to the stimulus “Green” and “Stop” to the stimulus
“Red”) and the “reverse” condition (i.e., respond “Stop” to
the stimulus “Green” and “Go” to the stimulus “Red”). La-
tencies were multiplied by (–1), so higher scores would cor-
respond to faster reaction times. Following exploratory and
confirmatory factor analysis (Lachman et al., 2010), two in-
tercorrelated, r(4027) = .43, p < .001, cognitive factors were
computed—episodic memory (immediate and delayed
word recall) and executive functioning (all other measures).
The two cognitive factor scores were computed as standard-
ized means of the z-scored measures loading on the factors.
BOLOS cognitive battery. As shown by the confirmatory
factor analysis in Miller & Lachman (2000), tasks at BO-
LOS Time 1 formed a four-factor model: short-term memo-
ry, speed of processing, reasoning, and vocabulary. The
memory factor was comprised of forward and backward
digit span (participants were read a string of numbers and
were asked to recall them in a forward and backward order,
respectively) and Serial 7’s (participants were asked to
count backwards by sevens from a given starting number;
Folstein, Folstein, & McHugh, 1975). The speed factor con-
tained letter comparison (participants judged two rows of
letters to be the same or different; Salthouse, Kausler, &
Saults, 1990) and digit symbol substitution (participants
were given a series of blank boxes with symbols above them
and had to fill in numbers corresponding to the symbols as
indicated by a provided legend; Wechsler, 1997). The rea-
soning factor, which captured visuospatial reasoning and
fluid intelligence, combined letter series—inductive reason-
ing (participants detected patterns in series of letters by de-
termining the letter that would logically follow; Schaie,
1985) and Ravens Advanced Progressive Matrices—figural
i133
relations (Raven, Raven, & Court, 1991). Vocabulary was
measured using the Wechsler Adult Intelligence Scale vo-
cabulary task (participants were given a word to define and
received points based on the completeness and accuracy of
their response; Wechsler, 1997). To compute each factor,
first, a z-score of each measure was taken, and then the
mean of these z-scores was standardized. The Time 2 cogni-
tive factors and measures were standardized using the
means and SDs from Time 1.
Frequency of engaging in cognitive activities.—The cogni-
tive activity variable (see Lachman et al., 2010) was created
by averaging the self-reported frequencies on a 6-point scale
(1 = never to 6 = daily) of engaging in four cognitive activities:
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reading books, magazines, or newspapers; doing word games
such as crossword, puzzles, or scrabble; attending educational
lectures or courses; and writing (e.g., letters, journal entries).
Psychosocial and behavioral factors.—Control beliefs.
Perceived control over outcomes in life was assessed with a
12-item composite (Cronbach’s a Time 1 = .85; Time 2 =
.87), computed by averaging scores on two subscales from
the MIDUS sense of control scale (Lachman & Weaver,
1998), namely personal mastery (e.g., I can do just about
anything I really set my mind to) and perceived constraints
(e.g., What happens in my life is often beyond my control).
The scores range from 1 (strongly agree) to 7 (strongly dis-
agree) and were reverse coded for personal mastery. A high-
er value indicates higher sense of control.
Quality of social support. We included items reflecting
social support and reverse coded items reflecting social
strain for close relationships. This measure (Cronbach’s a
Time 1 = .87; Time 2 = .88) was the average of the ratings
on 12 items assessing socioemotional aspects of social sup-
port (e.g., How much do members of your family really care
about you?) and 12 items assessing social strain (e.g., How
often do members of your family make too many demands
on you?) the participants experienced in their relationships
with family, friends, and spouse/partner (Lachman, Röcke,
Rosnick, & Ryff, 2008; Walen & Lachman, 2000). The
scores range from 1 (never) to 4 (often), with a higher value
indicating greater quality of social support.
Physical exercise. At Time 1, participants reported the fre-
quency of engaging in vigorous physical activities (e.g.,
running or lifting heavy objects) to work up a sweat, during
the summer months and the winter months (Cotter &
Lachman, 2010). The physical exercise score was the mean
of summer and winter ratings, which range from 1 (never)
to 6 (several times a week or more). At Time 2, six questions
assessing the participant’s frequency of vigorous physical
activities were used. These six questions referred to fre-
quency of physical activities during the summer and the
winter months, in three different settings (i.e., home, work,
i134 AGRIGOROAEI AND LACHMAN
and leisure), with ratings from 1 (never) to 6 (several times
a week). We computed the mean of the summer and winter
ratings for all three settings and used the highest of these
scores as the physical exercise score. At both occasions, a
higher score indicates more frequent physical exercise.
Psychosocial and behavioral protective composite. We as-
signed the participants a score of 0 (below the median) or 1
(equal to or above the median) for each psychosocial and
behavioral factor: control beliefs (MIDUS Median Time 1 =
5.67; Time 2 = 5.67), quality of social support (MIDUS Me-
dian Time 1 = 3.21; Time 2 = 3.29), and physical exercise
(MIDUS Median Time 1 = 4.50; Time 2 = 4); in BOLOS, the
medians were 5.83 (Time 1) and 5.75 (Time 2) for control
beliefs, 3.19 (Time 1) and 3.25 (Time 2) for quality of social
support, 4.5 (Time 1) and 4 (Time 2) for physical exercise.
At each occasion of measurement, one behavioral composite
was obtained by summing the assigned scores, for the par-
ticipants with available data on all protective factors. The
decision to create the composite using an unweighted sum is
based on previous work on accumulated risk (e.g., allostatic
load, Gruenewald, Seeman, Karlamangla, & Sarkisian,
2009). Also, it allows a parsimonious measure that is invari-
ant across all our dependent variables. The computed vari-
ables ranged from 0 to 3, with the higher values indicating a
greater number of factors at the higher level. The distributions
for each time point as well as for change over time are pre-
sented in Supplementary Tables 5–7 (in MIDUS, 20.9% of the
participants increased their protective composite by one factor,
5.1% by two, and .5% by three; in BOLOS, the corresponding
percentages were 30.4%, 5.2%, and 1.5%, respectively.
Sociodemographic variables.—We examined age, sex
(–1 = men, 1 = women), level of education in years (ranging
from 6 to 20 years), and self-assessed race (–1 = non-
Hispanic White, 1 = all others).
Physical Risk Factors
Waist circumference.—The circumference of the waist, a
reliable indicator of obesity (Chen & Guo, 2008), was mea-
sured in inches at the level of the navel and reported by the
participant at both times in MIDUS. For the data analysis, this
variable was standardized separately for men (Time 1: M =
37.55, SD = 4.40; Time 2: M = 39.46, SD = 4.91) and women
(Time 1: M = 33.17, SD = 5.53; Time 2: M = 35.45, SD = 6.06).
Smoking. At both occasions in MIDUS, participants were
asked if they currently smoke cigarettes regularly (–1 = no,
1 = yes).
Alcohol or drug problems. Participants reported if they have
experienced or have been treated for alcohol or drug prob-
lems during the past 12 months, at MIDUS Time 1 and
Time 2 (–1 = no, 1 = yes).
Health status.—This measure taken at Time 1 assessed
how many of the following conditions the participants report-
ed ever having: diabetes; stroke; lupus; human immunodefi-
ciency virus/acquired immunodeficiency syndrome; multiple
sclerosis, epilepsy or other neurological disorders; cancer; or
heart trouble (e.g., heart attack). Participants were assigned a
score of 1 for any of the chronic conditions. The final score
could range from 0 to 7.
Statistical Analysis
For the MIDUS analyses, we used all the available data.
However, we removed the 151 BOLOS participants from
the MIDUS analyses, to avoid redundancy. We used hier-
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archical multiple regression models to examine the effects
of the protective composite on episodic memory and ex-
ecutive functioning over and above the role of sociodemo-
graphic variables, physical risk factors, health status, and
cognitive activities (Step 2), and whether the age and edu-
cation differences in cognition can be moderated by the
number of behavioral factors (Step 3). In order to explore
how change in the number of protective factors over time
affected cognitive performance, we used as concurrent
predictors the Time 1 protective composite and the differ-
ence between the two occasions (Time 2 level – Time 1
level). All regression models adjusted for the effects of
sociodemographic variables, the physical risk factors,
health status, and engagement in cognitive activities
which were all measured at Time 2. As our sample also
included siblings of the main respondents and a subpopu-
lation of twins, we also ran models using the cluster op-
tion in STATA (StataCorp, 2009). This model takes
dependencies into account using robust standard errors by
clustering at the family level (see Supplementary Tables 8
and 9).
For the BOLOS analyses, we used all available data
from the 151 longitudinal participants. The measures of
the protective factors and all the covariates came from
MIDUS variables, and cognitive performance was as-
sessed in BOLOS within 12 months after the MIDUS
Time 1 and Time 2 interviews. In order to look at predic-
tors of change in cognition, we regressed the cognitive
factor from Time 2 on the same factor measured at Time
1 and entered sociodemographic variables, physical risk
factors, health status, and the protective composite from
Time 1 (Cohen, Cohen, West, & Aiken, 2003). At the last
step, we entered the interaction terms with education and
age, in order to explore if the association between the
protective composite and cognitive change varied by age
or educational attainment. Moreover, a separate regression
model tested whether change between Time 1 and Time 2
in the protective composite accounted for cognitive change
in BOLOS, following the same procedure as for MIDUS.
For correlations of all variables, see Supplementary Tables
10 and 11.
 PROTECTIVE FACTORS FOR COGNITION i135

Table 2.  Hierarchical Multiple Regression With Episodic Memory as the Dependent Variable (Midlife in the
United States Study)
Step 1 Step 2 Step 3
Unstandardized Unstandardized Unstandardized
(standardized) (standardized) (standardized)
parameter estimate SE parameter estimate SE parameter estimate SE
Age –.03 (–.33)** .001 –.03 (–.33)** .001 –.03 (–.33)** .001
Sex .44 (.22)** .031 .44 (.22)** .031 .44 (.22)** .031
Education .05 (.13)** .006 .05 (.13)** .006 .05 (.13)** .006
Race –.12 (–.07)** .026 –.12 (–.07)** .026 –.12 (–.07)** .026
Waist circumference –.04 (–.04)* .016 –.04 (–.04)* .016 –.04 (–.04)* .016
Smoking .01 (.01) .021 .01 (.01) .021 .01 (.01) .021
Alcohol or drug problems –.05 (–.01) .073 –.04 (–.01) .073 –.04 (–.01) .073
Health status –.04 (–.03) .024 –.03 (–.02) .024 –.03 (–.02) .024
Cognitive activity .17 (.15)** .018 .16 (.14)** .019 .16 (.14)** .019
Protective composite .04 (.03)* .017 .04 (.04)* .017

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Protective composite × age .00 (–.01) .001
Protective composite × education –.02 (–.04)* .006
Notes: Step 1: R2 = .230, F(9, 3366) = 111.66, p < .001; Step 2: R2 change = .001, F change (1, 3365) = 4.63, p = .032; Step 3: R2 change = .001, F change (2,
3363) = 2.94, p = .053. The outcome and all the predictors were measured at Time 2. Age, education, and the protective composite score were centered to the mean.
*p < .05; **p < .001.

Results demographic variables along with physical risk factors,

MIDUS
The results from the multiple regression models indicate
sociodemographic differences in cognitive performance. In
the first step of the regression model, advanced age was neg-
atively associated with episodic memory—Table 2; b = –.33,
t(3366) = –19.90, p < .001—and executive functioning—
Table 3; b = .40, t(3375) = –26.61, p < .001. Also, a positive
association was obtained between the level of formal educa-
tion and cognition—memory: b = .13, t(3366) = 8.10, p <
.001; executive functioning: b = .27, t(3375) = 18.23,
p < .001. Thus, our results are consistent with previous re-
search defining older adults and those with low education as
groups most at risk for poor cognitive performance. Socio
health status, and engagement in cognitive activities ac-
counted for a significant percent of variance in memory, R2 =
.230, F(9, 3366) = 111.66, p < .001, and executive function-
ing, R2 = .364, F(9, 3375) = 214.68, p < .001. However, in
line with our predictions, over and above the role of these
covariates, the number of behavioral protective factors was
positively associated with memory, b = .03, t(3365) = 2.15,
p = .032, and executive functioning, b = .06, t(3374) = 3.88,
p < .001, and added a significant percent of explained vari-
ance—R2 change = .001, F change (1, 3365) = 4.63, p = .032;
R2 change = .003, F change (1, 3374) = 15.08, p < .001, re-
spectively. The more protective domains people are engaged
in, the better their cognitive performance (Figure 1), and the
protective composite was equally beneficial across the board

Table 3.  Hierarchical Multiple Regression With Executive Functioning as the Dependent Variable (Midlife in the United States Study)
Step 1 Step 2 Step 3
Unstandardized Unstandardized Unstandardized
(standardized) (standardized) (standardized)
parameter estimate SE parameter estimate SE parameter estimate SE
Age –.03 (–.40)*** .001 –.03 (–.40)*** .001 –.03 (–.40)*** .001
Sex –.21 (–.10)*** .028 –.20 (–.10)*** .028 –.20 (–.10)*** .028
Education .10 (.27)*** .006 .10 (.27)*** .006 .10 (.27)*** .006
Race –.21 (–.12)*** .024 –.20 (–.12)*** .024 –.20 (–.12)*** .024
Waist circumference –.05 (–.05)** .014 –.04 (–.04)** .014 –.04 (–.04)** .014
Smoking –.05 (–.04)* .019 –.05 (–.03)* .019 –.05 (–.03)* .019
Alcohol or drug problems –.01 (.00) .066 –.01(.00) .066 .00 (.00) .066
Health status –.07 (–.05)** .021 –.07 (–.05)** .021 –.07 (–.05)** .021
Cognitive activity .19 (.17)*** .017 .18 (.16)*** .017 .18 (.16)*** .017
Protective composite .06 (.06)*** .015 .06 (.06)*** .015
Protective composite × age .00 (–.03) .001
Protective composite × education .00 (.00) .006
Notes: Step 1: R2 = .364, F(9, 3375) = 214.68, p < .001; Step 2: R2 change = .003, F change (1, 3374) = 15.08, p < .001; Step 3: R2 change = .001, F change (2,
3372) = 1.79, p = .167. The outcome and all the predictors were measured at Time 2. Age, education, and the protective composite score were centered to the mean.
* p < .05; **p < .01; ***p < .001.
i136
0.15
Episodic Memory (z-scores)
0.1
0.05
0 0
-0.05
-0.1
0 1
-0.15
Number of Psychosocial and Behavioral Factors
Figure 1.  The estimated means of episodic memory (left panel) and executive functioning (right panel) as a function of the number of psychosocial and behavioral
factors, while adjusting for sociodemographics, physical risk factors, health status, and cognitive activities.
for people of all ages. The results revealed that the associa-
tion between education and cognition was significantly
reduced by the number of protective factors (Figure 2), but
only for episodic memory—b = –.04, t(3363) = –2.43, p =
.015. The memory scores of people with fewer years of for-
mal education who engaged in three protective behaviors
were more comparable to those of respondents with higher
education. Finally, cognitive performance was significantly
associated with increases in the number of protective factors
between the two waves of MIDUS. While controlling for the
Time 1 composite and all other covariates at Time 2, increas-
ing the number of protective factors was significantly related
to better executive functioning—b = .03, t(3373) = 2.10, p =
.036. Over and above the psychosocial and behavioral pro-
file at Time 1, engaging in more protective behaviors over
Figure 2.  The predicted values for episodic memory by education and num-
ber of psychosocial and behavioral factors, while adjusting for sociodemo-
graphics, physical risk factors, health status, and cognitive activities; education:
M years = 14.15 (approximately some college), SD = 2.64; M –1SD = approxi-
mately high school or less; M + 1SD = approximately a bachelor’s degree or
higher.
AGRIGOROAEI AND LACHMAN
Executive Functioning (z-scores)
0.15
0.1
0.05
-0.05
-0.1
2 3 0 1 2 3
-0.15
Number of Psychosocial and Behavioral Factors
time was related to higher Time 2 executive functioning
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(in MIDUS, among all participants who increased by one,
two, or three factors, 35.96% increased in social support,
40.16% increased in control beliefs, and 50.51% increased
in physical exercise; in BOLOS, the corresponding per-
centages were 40%, 36%, and 48%, respectively). How-
ever, positive changes in the protective composite were
not significantly related to better episodic memory beyond
the effects of the Time 1 composite—b = .01, t(3364) = .38,
p = .706.
BOLOS
This subsample of MIDUS allowed us to look at change
in cognitive functioning and analyze cognitive decline in
relation to the number of protective factors. For the four
cognitive factors, there were significant mean differences
over time for short-term memory, speed of processing, and
reasoning—stability coefficients and mean differences be-
tween Time 1 and Time 2: short-term memory r(144) = .72,
p < .001; t(145) = 2.30, p = .023 (Time 1: M = 0, SD = 1;
Time 2: M = –0.12, SD = 1); speed r(139) = .78, p < .001;
t(140) = 2.90, p = .004 (Time 1: M = 0, SD = 1; Time 2: M
= –0.20, SD = 1.27); reasoning r(138) = .84, p < .001; t(139)
= 4.42, p < .001 (Time 1: M = 0; SD = 1; Time 2: M = –0.23;
SD = 1.05); and vocabulary r(142) = .84, p < .001; t(143) =
.51, p = .612 (Time 1: M = 0, SD = 1; Time 2: M = –0.03,
SD = .82); for each set of analysis, the maximum number of
longitudinal participants was used. There was considerable
cross-occasion stability in all factors. Individual differences
in change in short-term memory and reasoning were sig-
nificantly associated with age. However, the Time 1 protec-
tive composite was positively associated with change only
for reasoning (Table 4), beyond the role of sociodemo-
graphic variables, physical risk factors, and health status, b
= .10, t(126) = 2.02, p = .045. Moreover, when the interac-
tion terms between the protective composite and age and
education were entered in the model, the number of factors
reduced the association between level of education and rea-
soning abilities, b = –.09, t(124) = –2.03, p = .045. Regard-
ing the effects of change in the protective composite
 PROTECTIVE FACTORS FOR COGNITION i137

Table 4.  Hierarchical Multiple Regression With Reasoning at Time 2 as the Dependent Variable (Boston Longitudinal Study)
Step 1 Step 2 Step 3
Unstandardized Unstandardized Unstandardized
(standardized) (standardized) (standardized)
parameter estimate SE parameter estimate SE parameter estimate SE
Reasoning Time 1 .73 (.69)*** .059 .74 (.70)*** .058 .74 (.70)*** .058
Age –.02 (–.23)*** .004 –.02 (–.22)** .004 –.02 (–.22)** .004
Sex –.04 (–.02) .096 .00 (.00) .097 –.02 (–.01) .096
Education .03 (.08) .020 .03 (.06) .020 .02 (.04) .021
Race –.15 (–.06) .114 –.11 (–.05) .114 –.09 (–.04) .113
Waist circumference –.04 (–.03) .051 –.04 (–.04) .050 –.05 (–.04) .050
Smoking .01 (.01) .069 .01 (.01) .068 .01 (.01) .068
Alcohol or drug problems .05 (.02) .147 .06 (.02) .145 .05 (.01) .145
Health status .01 (.01) .083 .03 (.02) .082 .02 (.01) .082
Protective composite .10 (.10)* .051 .09 (.08) .051
Protective composite × age .00 (–.02) .004

Downloaded from psychsocgerontology.oxfordjournals.org at University of Wisconsin-Madison General Library System on August 31, 2011
Protective composite × education –.04 (–.09)* .018
Notes: Step 1: R2 = .752, F(9, 127) = 42.85, p < .001; Step 2: R2 change = .008, F change (1, 126) = 4.10, p = .045; Step 3: R2 change = .008, F change (2, 124)
= 2.15, p = .121. The outcome and all the predictors were measured at Time 2. Age, education, and the protective composite score were centered to the mean. The
model did not adjust for cognitive activities because this was measured at Time 2, only.
* p < .05; **p < .01; ***p < .001.

between Time 1 and Time 2, increasing the number of pro-
tective factors did not lead to better maintenance of reason-
ing abilities over and above the Time 1 factors, b = –.01,
t(117) = –.23, p = .823.
Discussion
The present study revealed that a composite index of the
number of adaptive psychosocial and behavioral factors
was positively related to cognitive performance (episodic
memory and executive functioning) and change (reasoning
abilities), over and above the role of physical risk factors,
health status, and cognitive activities (MIDUS). Whereas
previous studies have examined these factors individually,
the present study demonstrates the cumulative association
and protective value for cognitive functioning. Interest-
ingly, the effects of the protective factors were equally ben-
eficial across adulthood and into old age. Another key
promising finding was that education differences in epi-
sodic memory and declines in reasoning abilities were sig-
nificantly attenuated as a function of the number of
protective factors. In previous work, we had a similar find-
ing in that engaging in frequent cognitive activity compen-
sated for education differences in episodic memory
(Lachman et al., 2010). In the current study, this mitigating
role was extended to noncognitive protective factors. This
suggests that the cognitive risks traditionally associated
with low educational attainment can be attenuated by mod-
ifying a large spectrum of lifestyle factors. However, for
executive functioning, the effects of education were not re-
duced by the protective factors as they were for episodic
memory. Perhaps, one clue comes from the BOLOS analy-
ses. In that case, changes in reasoning were attenuated by
the protective factor, especially for those with lower educa-
tion. Thus, it may be that education effects for those aspects
of cognitive performance that depend on strategic behav-
iors are more likely to be attenuated with psychosocial and
behavioral factors. In contrast, education differences in-
volving speed and attentional processes may be less ame-
nable to behavioral factors.
Engaging in a greater number of protective lifestyle fac-
tors was associated with better cognition both in the cross-
sectional and longitudinal analyses. The patterns obtained
in MIDUS also showed that those who adopted additional
protective behaviors between the two occasions of measure-
ment showed improved executive functioning. However,
increases in protective behaviors did not improve episodic
memory or reasoning beyond the protective effects at Time
1. Further work is needed to explore why only executive
functioning was related to changes in protection.
To our knowledge, this is the first time that the combined
contribution of psychosocial and behavioral factors to cog-
nitive performance has been analyzed, and these results
have valuable public health relevance. Importantly, the
protective factors we examined are modifiable. Several
studies have shown and reviewed the efficacy of interven-
tions to change control beliefs (e.g., Lachman, Neupert, &
Agrigoroaei, 2011), physical activity (e.g., Yan, Wilber,
Aguirre, & Trejo, 2009), and social support (e.g., Berkman
et al., 2003; Rains & Young, 2009). Therefore, these factors
could be considered in the design of future multiple-behavior
interventions or lifestyle programs (Small et al., 2006).
Also, knowing someone’s standing on the protective com-
posite could allow the identification of the persons most at
risk for cognitive decline. For example, those at retirement
age are a vulnerable group, given their potential for de-
creases in social exchanges, control beliefs, and frequency
of physical exercise. Thus, this group could be targeted and
encouraged to engage in diverse activities providing a high
i138 AGRIGOROAEI AND LACHMAN
sense of control, quality social support, and opportunities
for physical activity.
We acknowledge that the obtained patterns must be con-
sidered in light of some inherent limitations. The generaliz-
ability of our findings is limited to some extent by the
positive selection of the longitudinal participants in MIDUS
and BOLOS and the relatively small sample size of BO-
LOS. Also, even though the data are from a large national
probability-based sample, the median split approach used to
compute the protective composite is sample dependent and
cannot provide universal guidelines. Although it is a reason-
able method given the lack of clinically meaningful criteria
for dividing participants into high and low categories, future
studies should consider different approaches for computing
protective factors using different cutoffs, weighted scores,
or continuous scales.
Although the design from the larger MIDUS study was
cross-sectional, it is encouraging that the findings were es-
sentially replicated with the longitudinal sample in which
we found the protective factor related to change with one
key cognitive dimension: reasoning. Also, the validity of
some of our self-reported measures (e.g., waist circumfer-
ence, physical exercise) could be optimized using multiple
indicators. Furthermore, the amount of variance accounted
for by the psychosocial and behavioral factors was in the
small range. Along with the factors we considered in the
current study, other variables can play a role in cognitive
functioning (Hertzog et al., 2008) and should be considered
as protective factors or covariates in the statistical models.
For instance, level of stress (Neupert, Almeida, Mroczek, &
Spiro, 2006), personality profiles (Pearman, 2009; Willis &
Boron, 2008), and healthy nutrition (Del Parigi, Panza,
Capurso, & Solfrizzi, 2006) also account for between-per-
son heterogeneity in cognitive performance, directly or via
physical health.
In spite of these limitations and the fact that the current
design does not provide a final answer concerning causal-
ity, the present study provides a plausible examination of
the role of the synergistic effects of high control beliefs,
frequent physical activity, and high-quality social sup-
port, on cognitive functioning and long-term change.
However, future work is needed to examine this set of
protective factors in relation to long-term changes in
multiple aspects of cognition, including the risk of
dementia, and to explore the individual and shared mech-
anisms (e.g., stress hormones, McEwen, 2008; inflamma-
tion processes, Ferrucci et al., 1999; allostatic load,
Gruenewald et al., 2009) that may be involved in linking
the combined psychosocial and behavioral factors to
cognitive functioning.
Funding
This work was supported by the National Institute on Aging (RO1
AG 032271, RO1 AG17920, PO1 AG20166) and the John D. and Cath-
erine T. MacArthur Foundation Research Network on Successful
Midlife Development.
Supplementary Material
Supplementary tables can be found at: http://psychsocgerontology.
oxfordjournals.org/.
Acknowledgments
The article was written while the second author was a fellow at the Center
for Advanced Study in the Behavioral Sciences at Stanford University and a
member of the working group sponsored by the Stanford Center on Longevity.
Correspondence
Correspondence should be addressed to Stefan Agrigoroaei, PhD, De-
partment of Psychology, Brandeis University, MS 062, Waltham, MA
02454. E-mail: stefana@brandeis.edu.
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